There been a sea change of sorts on Medicaid expansion by two of the largest business groups in Florida.

Formerly speaking against nearly all aspects of the Affordable Care Act (ACA), both the Associated Industries of Florida (AIF) and the Florida Chamber of Commerce have recently come out in support of ACA’s Medicaid expansion in Florida – although with a number of caveats. Their change in view highlights why Medicaid expansion has become a pressing issue for the state’s businesses.

Governor Rick Scott, previously an opponent of all things ACA, surprised many last month when he voiced his support for Medicaid expansion, at least for the first three years. The federal government would cover the entire cost of the eligibility expansion of up to 138 percent of the federal poverty level for those three years, with federal support eventually declining to 90 percent of the cost.

“Governor Scott has proposed an option to relieve the double taxation on Florida’s employers, while also providing coverage for more of our state’s uninsured,” AIF President and CEO Tom Feeney stated. “AIF stands ready to work with the Florida Legislature and the Governor to accomplish these critical objectives for the benefit of all Floridians.”

Why does AIF call it a double taxation? AIF testified before the state legislature that the cost of treating the uninsured is a $1.3 billion “hidden tax” on Florida’s employers. Hospitals pass on the cost of treating the uninsured in the emergency room to businesses that carry insurance. Miami-Dade, Broward and Palm Beach counties all have dedicated sources of taxes that fund uninsured care at either public hospitals or trauma centers.

Rejecting Medicaid expansion would forfeit billions of dollars in federal funding, AIF added. That money could be leveraged to reduce the state’s expenses for treating the uninsured.

Another benefit of Medicaid expansion for businesses is that having an employee enroll in Medicaid means the company wouldn’t pay a $2,000 penalty for not offering them affordable health insurance. Those fines under ACA start in January.

On Monday, the Florida Chamber’s board of directors approved 11 prerequisites that should be met in order to expand Medicaid. They include limiting Medicaid expanses to 32 percent of the state’s budget, implementing medical liability reform, and increasing the training of doctors, nurses and medical technicians in the state.

“Before accepting federal funding, Florida must agree to lower the cost of healthcare, implement smart solutions that will closely monitor and evaluate quality care and savings, and direct its focus on the long-term competitiveness of our state,” the Florida Chamber stated.

Does the support, albeit limited, from business groups give Medicaid expansion a better chance of passage? That would be difficult to predict. Influential donors can often get the ears of lawmakers, but they still have to answer to constituents in their districts. However, many of Florida's Republican lawmakers come from heavily conservative districts and the Tea Party still wants to toss ACA in the nearest harbor.